1505 112TH ST SW 2018-01-02 MF Import

Datela'VC"91 Application For PUBLIC WORKS PERMIT Print or Type Only Public Works Permit # Bldg. Dept. # Public Works Fee Total Fee $ Less Appl. Fee Paid $ Balance Due $ l `'7, � .fey no f fp'oi i c2� S � .SGJ. x'c'e ei? eg- 3 S�3 � l5-0 Owner Mailing Address City Zip Phone JF Applicant Mailing Address City Zip Phone Describe Proposed Work )�i �l iA..# /sdsec 4=0a4 P�> '!-12ai Z1' G�St� -L Project Address (if known) Attach four (4) copies of plans for proposed work - Draw to scale and note the following as applicable: • Property Lines • Centerline of street • Outline and dimensions of all existing and • Indicate North proposed structures on the lot • Show any proposed grading changes • Existing and proposed utilities • Show measurements NOT WRITE BELOW THIS LINE PERMIT CONDITIONS 1. All calls for inspection shall be made 24 hrs. in advance - phone 259-8810. 2. All work shall be performed in accordance with this permit and current City of Everett Design and Construction Standards and Specifications. 3. Call Location Underground Service 48 hrs. before you dig. TOLL FREE NUMBER 1-800.424-5555. Approved for Construction Date FINAL INSPECTION Date Approved as Constructed PUBLIC WORKS DEPARTMENT off I _i 3200 Cedar Street Everett, WA 98201 Phone: 259-8810 ACKNOWLEDGEMENT OF CONDITIONS The undersigned owner/applicant hereby agrees to hold and save harm- less the City of Everett from any and all claims for damages, costs, expenses, or causes of action that may arise because of installation and maintenance of the improvement or other right-of-way use hereto applied for and further agrees to remove same upon notice from the City and to replace public property damaged thereby. Signature of Applicant Date. WORK AUTHORIZED BY THIS PERMIT MUST BE STARTED WITHIN 180 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO BE DILIGENTLY PURSUED TO COMPLETION. THIS PERMIT MAY BE CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS PROJECT OVER 90 DAYS DURATION.